POS1171 TRIPLE THE RATE OF EMERGENCY ROOM VISITS AND HOSPITALIZATIONS FOR GOUT AMONG US BLACKS VS WHITES – 2019 NATIONWIDE ANALYSIS
Authors: C. Yokose, N. Mccormick, N. Lu, A. Joshi, L. Jackson, M. Kohler, J. Yinh, Y. Zhang, K. Saag, H. Choi
Journal: Annals of the Rheumatic Diseases (2022)

Background Gout is a highly prevalent inflammatory arthritis with increasing global disease burden in recent years. 1,2 Gout prevalence has been reported to be higher among Blacks compared to Whites, 3 and that they are less likely to receive allopurinol in outpatient care. 4 The potential nationwide impact of these racial disparities on emergency department (ED) visits and hospitalizations is unknown. Objectives To examine the contemporary racial disparities in ED visits and hospitalizations with a primary discharge diagnosis of gout in the US (2019). Methods We compared ED visits and hospitalizations between Blacks and Whites in the latest data (2019) from the US National Emergency Department Sample (NEDS) and National Inpatient Sample (NIS). We focused on encounters for which the primary diagnosis was gout based on ICD codes (M1A.xx, M10.xx). We calculated annual population rates of ED visits and hospitalizations for gout (per 100,000 US adults) using the 2019 US census adult population (&gt;18 years) according to race. Results There were a total of 160,759 ED visits and 9,560 hospitalizations among White and Blacks with a gout diagnosis in the US in 2019. The mean age (58.2 years vs. 56.5 years) and male proportion (78.0% vs. 74.8%) tended to be higher among Whites, while more Blacks tended to live in the South (40.7% vs. 66.5%) and reported a median household income of &lt; $50,000 (30.7% vs. 57.1%). Compared to Whites, Blacks had 2.7- and 3.2-fold higher rates of gout ED visits and hospitalizations, respectively, after adjusting for age, sex, payer, region, and household income (Table 1 &amp; Figure 1). Black women, in particular, had 3.4- and 4.0-fold higher rates of ED visits and hospitalizations compared to White women, while the corresponding rate ratios for men were 2.5 and 2.8, respectively. The mean costs per gout ED visit were similar for Blacks compared to Whites (adjusted difference, -$7.6 [95% CI, -25.4 to 1.0]), while hospitalizations were more costly (adjusted difference, $1,055.3 [95% CI, 553.1 to 1557.5]). The duration of ED visits and hospitalizations was also higher among Blacks than Whites (adjusted difference of 0.41 days [95% CI, 0.19 to 0.63] and 0.59 days [95% CI, 0.25 to 0.94], respectively). Table 1. Racial Disparities in Emergency Department Visits and Hospitalizations with Primary Diagnosis of Gout in 2019 Emergency Department Visits Hospitalizations Race White Black White Black All 68011965 24521330 19851043 4519150 Visits, N 88810 71949 6200 3360 Rate per 100,000 130.6 293.4 31.2 74.4 Rate Ratio (95% CI)* 1.0 (ref) 2.81 (2.63, 3.00 ) 1.0 (ref) 3.08 (2.79, 3.40 ) Rate Ratio (95% CI)** 1.0 (ref) 2.66 (2.50, 2.82 ) 1.0 (ref) 3.17 (2.86, 3.50 ) Women 37851369 14363031 11039093 2647105 Visits, N 19567 18163 1770 1145 Rate per 100,000 51.7 126.5 16.0 43.3 Rate Ratio (95% CI)* 1.0 (ref) 3.68 (3.39, 3.99 ) 1.0 (ref) 4.01 (3.40, 4.73 ) Rate Ratio (95% CI)** 1.0 (ref) 3.36 (3.11, 3.62 ) 1.0 (ref) 4.02 (3.39, 4.78 ) Men 30156101 10156573 8809815 1871620 Visits, N 69228 53783 4430 2215 Rate per 100,000 229.6 529.5 50.3 118.3 Rate Ratio (95% CI)* 1.0 (ref) 2.59 (2.42, 2.78 ) 1.0 (ref) 2.66 (2.36, 3.00 ) Rate Ratio (95% CI)** 1.0 (ref) 2.47 (2.32, 2.64 ) 1.0 (ref) 2.77 (2.45, 3.14 ) *Adjusted for age and sex for all, adjusted for age for sex-specific rate ratios **Adjusted for age, sex, payment, region, and household income Conclusion These latest national data indicate that ED visits and hospitalization due to gout are both 3 times higher among Blacks than Whites; this disparity was particularly prominent among women with gout. Higher risk of developing gout 3 and suboptimal care 4 both translate to these avoidable costly healthcare utilizations, calling for improved primary prevention and gout care. References [1]Safiri et al., PMID 32755051 [2]Xia et al., PMID 31624843 [3]Chen-Xu et al., PMID 30618180 [4]Krishnan et al., PMID 18260174 Disclosure of Interests Chio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Lesley Jackson: None declared, Minna Kohler Speakers bureau: Lilly, Consultant of: Mymee, Novartis, Grant/research support from: Setpoint Medical, Janeth Yinh: None declared, Yuqing Zhang: None declared, Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Horizon Therapeutics, SOBI, Shanton, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon